Anterior Approach Spine Fracture

Question:

Good day, my surgeon did a fracture treatment from the anterior approach on the C6-C7 spine; however, he did not do a corpectomy. Should I use the corpectomy code with a 52 modifier or an unlisted code? I was thinking of the comparable code as 22319. Thank you.

Answer:

In spine coding, there are no anterior fracture repair codes outside of the repair of an odontoid fracture. Typically, anterior fracture treatment is reported using existing anterior approach codes, such as anterior cervical discectomy and fusion (ACDF) or corpectomy, depending on the extent of the procedure.

Based on the information provided, it’s unclear precisely what was performed during the surgery, aside from the fact that a corpectomy was not done. Without access to the operative report or more detailed documentation, it’s challenging to make a definitive coding recommendation.

That said, here’s some general guidance: if the vertebral body bone is removed but does not meet the threshold for a corpectomy (which requires removal of at least 50% of the vertebral body for cervical), the procedure would typically be reported as an ACDF. Reviewing the operative note closely or consulting with the surgeon may help clarify whether the procedure aligns more closely with ACDF or warrants the use of an alternative code.

Thank you for reaching out to KZA with your inquiry.

*This response is based on the best information available as of 01/08/26.

Modifier for Postoperative Endoscopic Sinus Debridement

Question:

If one of our physicians performs a septoplasty and sinus surgery and then the patient comes in the office for a 31237 (endoscopic sinus debridement), would we use a modifier 79 (unrelated procedure in a global period) or 58 (staged/anticipated procedure in a global)?

Answer:

The debridement should be considered unrelated to the septoplasty because septoplasty does not routinely require postoperative debridement. Therefore, modifier 79 should be appended to 31237 when the service occurs within the septoplasty’s global period.

Ensure that diagnosis codes are properly linked to the indication for the sinus surgery and the 31237. If 31237 is linked to the septoplasty diagnosis, the payer system will interpret the procedure as related to a 90-day global and may cause a denial.

*This response is based on the best information available as of 01/08/26.

Diastasis Recti Repair

Question:

What is the recommendation for coding an open Diastasis Recti repair, when it is the only procedure performed?

Answer:

There is no specific CPT code for open repair of a Diastasis Recti. If it is the only procedure performed, it is reported with an unlisted code, 49999 or 22999. If it is performed at the same session as an abdominal hernia repair, it is considered part of the reconstruction of the hernia repair and is not separately reported.

*This response is based on the best information available as of 01/08/26.

A Tale of Two Pulleys: Can 26055 and 26160 Share the Same Bill?

Question:

Hello, I am inquiring about a bundling scenario my Physician and I are having some differences on and I wanted to get an opinion from you on it. We have cases where the trigger finger will be released at the level of the A1 pulley and the surgeon will lift the edge of the wound and take some dissection towards the A2 pulley and then excise said cyst from the A2 pulley. Our surgeon is wanting this unbundled for being separate issues and I am looking at it being done from the same incision seeing problems with Insurance. I will leave the documentation so nothing is left out for decision factor. Thank you in advance for your help.

After incision at distal palm overlying A1 pulley, veins protected, etc.:

".... The A1 pulley was incised longitudinally out to the proximal A2 pulley. proximally the fascial pulley was similarly divided. tendons were inspected, synovitis noted on the flexor tendons which was identified and debrided. Fraying tendon not present. There was no recurrent triggering with active flexion. In the area where the patient noted a mass was explored. This was along the proximal digital crease. By elevating the dorsal edge of the wound, dissection was taken out and a small retinacular cyst was noted to be coming off the A2 pulley. This was sharply excised...." They go on the close the incision

Answer:

I can appreciate the dilemma in this scenario.

In reviewing the AMA vignette for CPT code 26055, it describes releasing the trigger finger of the A1 pulley while "taking care to maintain the integrity of the A2 pulley." The American Academy of Orthopaedic Surgeons Global Service Data (GSD) states the "incision or resection of flexor tendon sheath, distant site (eg, 26055)" is not included in CPT 26160.

From a CPT perspective both can be billed together with supporting documentation, including the diagnosis header and indications paragraph of two distinct issues at different sites. Subset modifier XU (non-overlapping structure) would need to be appended.

*This response is based on the best information available as of 01/08/26.

Laparoscopic Approach for Shunt

Question:

Can unlisted code 49320 or 49329 be coded along with 62223-62 for a General Surgeon who was a co-surgeon for ventriculo-peritoneal shunt creation if he used a laparoscopy?

Answer:

No, reporting either 49320 or 49329 for the laparoscopic approach is not appropriate.

According to the December 2012 issue of CPT Assistant, code 62230 with modifier 62 may be used by a general surgeon performing the procedure laparoscopically. The provided explanation states that the essential portion of the operation remains the same, and the incision size is not a factor.

Based on this guidance, the correct coding for this scenario is 62223-62 for both the general surgeon and the neurosurgeon.

*This response is based on the best information available as of 12/18/25.

Complication: Back to OR

Question:

Can we bill separately for taking a patient back to the OR on postoperative day 2 to explore and repair a postoperative hemorrhage? I’ve heard that complications like this are usually included in the payment for the original surgery.

Answer:

Yes, you can bill for this. Both CPT and Medicare guidelines allow separate billing when a patient returns to the OR to treat a complication.

In this case, report the procedure code(s) for the services performed to address the postoperative hemorrhage. Be sure to append modifier 78 to indicate an unplanned return to the OR and assign the appropriate ICD-10 code for postoperative hemorrhage.

Thank you for reaching out to KZA regarding your inquiry.

*This response is based on the best information available as of 12/18/25.